https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article Knowledge of High School Teachers Regarding Healthful School Environment in Erbil City ABSTRACT Background and Objectives: A healthy school environment focuses on providing a suita- ble setting for learning and healthy behaviors because the school environment represents an important setting for many children’s social habits and behaviors that are learned at school. The purpose of this study was to assess the high school teachers in Erbil City's public and private schools' knowledge of a healthy learning environment. Method: An across-sectional survey was conducted to determine teachers' knowledge regarding a healthful school environment. The study included 360 teachers in Erbil city, 260 from public schools and 100 from private schools. A questionnaire was constructed for the purpose of data gathering. Results: more than half (64.6%) of teachers of the public schools were aged 38-50 com- pared with 21% of teachers of the private schools; 51.2% of the teachers of the public schools were male compared with 64% of the private teachers; 81.9% of the teachers in the public schools were married compared with 69% of the private school teachers; and the majority (86%) of the private teachers had Bachelor degrees compared with 95.8% of teachers of the public schools. The highest percentage (74.6%) of the public teachers had a fair level of knowledge compared with 56% of teachers of the private schools. Conclusion: Based on the study findings of the present study, it was concluded that the highest percentage of the teachers had a fair level of knowledge regarding school health policies. Keywords: School Health Policy; Knowledge; Teachers. Bakhtiyar Fattah Saleh; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: bakhtiarfattah8@gmail.com) Salih Ahmed Abdulla; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 103 Received: 10/09/2022 Accepted: 12/12/2022 Published: 30/05/2024 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:Bakhtiarfattah8@gmail.com mailto:Bakhtiarfattah8@gmail.com mailto:Bakhtiarfattah8@gmail.com?subject=Bakhtiarfattah8@gmail.com%20%20 mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article A healthy school environment focuses on providing a suitable setting for learning and healthy behaviors, which is insufficient in the majority of schools and exposes staff members and children to different health risks. To improve health among staff mem- bers and children in schools, adequate un- derstanding of and adherence to healthy school environments are required [1].According to the World Health Organi- zation (WHO, 2010), a healthy school envi- ronment includes the school's physical structure, infrastructure, furniture, use of chemicals, and biological agents, as well as the site where the school is located and the immediate environment, including the air, water, and materials that kids may come into contact with[2].Because many of a child's social norms and behaviors are learned in the classroom, the school envi- ronment is a crucial context [3]. The school is the children's second-most-important learning environment after the home, and it plays a significant role in the community [4].The implementation of a healthy school environment was assessed putting into consideration the availability or presence of facilities that are basic to its implemen- tation and that are conducive to optimal physical, mental and emotional health, safety of the pupils amongst all members of staff and students [5]. A key component of the School Health Program is a healthy school environment. The term "Healthy School Environment" refers to any careful- ly planned, organized, and carried out ac- tions to guarantee safety and wholesome living conditions for all members of the school community. The level of intellectual growth and development of a person is significantly influenced by their school en- vironment, which includes physical, biolog- ical, and sociocultural factors. The goals of a healthy school environment are to estab- lish a secure and healthy learning environment as well as adequate safe water supplies and restrooms for use in classrooms [6].Health is essential to everyone's life. Everyone has to be in good health. Even though, everyone is in good health that needs to be maintained constantly. This knowledge will cause schools to adjust in order to care for children's health issues. A country's overall system for delivering healthcare should include a school health program [7]. A healthy school environment includes everything surrounding a school that has an impact on students' physical, mental, and emotional health [8].Additionally, it presents an opportunity to guarantee the life cycle approach required for a kid's development as in addition to services for maternal and child health [9].According to Ezeonu et al, the National School Health Policy was passed and accepted in Nigeria in 2006 as a manual for carrying out the School Health Programme to maintain and enhance the health of students[10].As a result, it serves as both a legal foundation and a declaration of the government's commitment to protecting students' health at school. Future health may be contributed to and wisely ensured by making investments in children's health today. Through the ongoing execution of the sustainable development objective of "Ensuring an inclusive and excellent education for all and encouraging lifelong learning" as the cornerstone to improve people's lives and sustainable development, the school provides a great chance to reach many youngsters [11]. An across-sectional was conducted to determine teachers' knowledge regarding ahealthy school environment. 360 teachers were recruited for the study (260 teachers from public schools and 100 teachers from private schools) in Erbil city/ Kurdistan 104 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article of overall teachers’ knowledge about school health policy documents (14 items) was categorized into three groups' poor knowledge (0-4.8), fair knowledge (4.9- 9.7), and good knowledge (9.8-14). The data were analyzed by using Statistical Package for Social Sciences (SPSS) software for statistical analysis Version 26, for calcu- lating descriptive statistical analysis (frequency and percentage). Inferential statistical analysis (Chi-square test, Fisher’s exact test, and independent sample t-test) was used to determine the association be- tween variables. The P-value is considered statistically significant if it's ≤ 0.05 which rejects the null hypothesis. The Scientific and Ethics Committee of the College of Nursing at Hawler Medical University gave its approval to the study (code 112) on 7/10/2021 before starting the research. The formal consent form was taken from the Ministry of Education in Erbil. The re- spondents' rights and confidentiality were protected throughout the study. They were informed and explained the goal of the study as well as the confidentiality of the information through a verbal permis- sion process. Three hundred and sixty teachers were included in the study. Their mean age (SD) was 39.8 (8.3) years, ranging from 25 to 63 years; the median was 40 years. Table 1 shows that the majority (74%) of private school teachers were aged (25-37), young- er than public schools (64.6%) were aged between (38-50) years (p < 0.001).The per- centage of male in private school teachers was (64%), which was higher than male in public school teachers from 51.2% (p = 0.028).The majority (81.9%) of the teach- ers in the public schools were married compared with 69% of the private school teachers (p = 0.046).The highest (95.8%) of the public teachers had bachelor degrees Region, from 1st November 2021 to 1st November 2022. A non-probability/ convenience sampling technique was used to collect the data. The Scientific and Eth- ics Committee of the College of Nursing at Hawler Medical University gave its approv- al to the study (code 112) on 7/10/2021 before starting the research. The formal consent form was taken from the General Directorate of Education in Erbil, in both public and private schools to conduct the study. The inclusion criteria are composed of (high schools located in Erbil city, teach- ers of both genders who are willing to par- ticipate in the study and are available dur- ing the study). Exclusion criteria included (Students, non-teaching staff, crop mem- bers, students participating in teaching practice, and teachers who refused to par- ticipate in the study were all excluded from the study. the high schools not locat- ed within the Erbil city, non-teaching staff, teachers that experience less than 2 years and teachers that refuse to take part in the study). A semi-structured instrument was designed after reviewing related literature on school health policy Documents and perceived knowledge that related to healthy school environments. Two parts were used for data collection. Part one in- cludes socio-demographic characteristics and the professional background of the teachers. This part contains information such as age, gender, marital status, level of education, years in service, subject taught, monthly income, house ownership and car ownership. Part two: knowledge of school health policies. The inquiries are open- ended. Respondents to the open-ended questions were required to provide a "Yes," "No," or I don't know" response. Regarding the rating and scoring of the scales, the responses to the teachers’ knowledge about school health policy doc- ument items included two answers (0 = Incorrect and 1= Correct). The calculation 105 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article compared with 86% of teachers in the pri- vate schools (p = 0.001).Around one- quarters(14%) of the private teachers had postgraduate degrees compared with 4.2% of teachers in the public schools (p = 0.001).Regarding the duration of service, around two-thirds (65%) of the private teachers served less than 10 years in teach- ing compared with 10.4% of teachers in public schools. On the other hand, 35.4% of the public teachers had served 20 years or more as teachers compared with 11% of the private teachers (p < 0.001). There was no significant difference be- tween public and private teachers in the subjects they taught (p = 0.643). No signifi- cant difference was noticed in the income of teachers of the two groups (p = 0.105). Regarding house ownership, 61.2% of the teachers in the public schools owned a house compared with 47% of teachers in the private schools (p = 0.016). Finally, 85.8% of teachers of the public schools owned a car compared with 77% of the private teachers (p = 0.046). 106 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Characteristics of study samples of high school teachers. Socio-demographic Characteristics School P-Value Public Private F. (%) F.(%) Age Group (years) 25-37 60 ( 23.1 ) 74 (74) < 0.001 VHS 38-50 168 (64.6) 21 (21) 51-63 32 (12.3 ) 5 (5) Gender Male 133 (51.2) 64 (64) 0.028 S Female 127 (48.8) 36 (36) Marital Single 44 (16.9) 30 (30) 0.046 S Married 213 (81.9) 69 (69) Divorced 2 ( 0.8 ) 1 (1) Widowed 1 (0.4) 0 (0) Education Bachelor degree 249 (95.8) 86 (86) 0.001 VHS Postgraduate 11(4.2 ) 14 (14) Service duration < 10 27 (10.4) 65 (65) < 0.001 VHS 10-19 141 (54.2) 24 (24) 20+ 92 (35.4) 11 (11) Subject taught English 33 (12.7) 16 (16) 0.643 NS Kurdish 23 (8.8 ) 13 (13) Arabic 32 (12.3) 12(12) Mathematic 28 (10.8) 14(14) Physic 21 (8.1 ) 7 (7) Chemistry 28 (10.8) 12 (12) Biology 32 (12.3) 8 (8) Others 63 (24.2) 18 (18) Income Sufficient for daily needs 136 (52.3) 64 (64) 0.105 NS Insufficient for daily needs 122 (46.9) 36 (36) Exceeds ne 2 (0.8 ) 0 (0) House Owned 159 (61.2) 47 (47) 0.016 S Partially owned 41 (15.8) 15 (15) Rented 45 (17.3) 24 (24) Others 15 (5.8 ) 14 (14) Car Yes 223 (85.8) 77 (77) 0.046 S No 37 (14.2 ) 23 (23) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article 107 teachers knew that a safe physical, bio- logical, and socio-emotional climate in the school is one of the components of the school health program, and there was no significant difference between the two groups (p = 0.468). The majority of the teachers (88.6%) were aware that a school might be considered healthy if it promotes intimate relationships between the school, home, and community and there was no significant difference be- tween the two groups (p = 0.339). The table shows that only 16.7% (27% of the private and 12.7% of the public) of the teachers have a copy of the national school health policy in their school (p = 0.001). More than one-third (37.5%) of the teachers mentioned that their school has written health-related guidelines or policies for use (51% of the private teach- ers compared to 32.3% of the public teachers, p = 0.001). More than one-third (35.8%) of the teachers mentioned that there is a procedure in place to monitor and enforce proper implementation of the mentioned policies in their school (56% of the private compared to 28.1% of the public teachers, p < 0.001). The majority (85.8%) of teachers consider that the school health policy encourages skill-based health education (89.2% of the public teachers compared to 77% of the private teachers, p = 0.001). Table 2 shows that more than half (52.3% of public and 58% of private) of the teach- ers have information about school health policy, but there was no significant differ- ence between both groups of teachers (p = 0.398). More than two-thirds (68.1%) of public school teachers compared to 74% of private school teachers knew the school health policy is a written guideline which helps in the effective monitoring and evalu- ation of the school health program, and no significant difference was detected be- tween the two groups of teachers (p = 0.403). More than three-quarters of (79.2) public school and (81%) private school teachers knew the school health program helps in the promotion of health and devel- opment of the school community(p = 0.398). Only 19.7% of teachers knew that the school health policy was formulated by the ministry of education, One-quarter of private teachers knew about that, com- pared with 17.7% of public teachers (p = 0.001). Around three-quarters of (72.3%) public school and (75%) private school teachers knew that the school health policy is a structure that successfully monitors the duties of participants in the school. No sig- nificant difference was perceived between the two groups of teachers (p = 0.795). Around two-thirds (63.8%) of public school teachers and (58%) private school teachers knew that the school health policy was for- mulated in joint conjunction with the min- istry of health and education. No significant difference was noted between the private and public school teachers (p = 0.583). More than three-quarters (77.2%) of the teachers knew that the school health pro- grams enhanced the comprehension and learning abilities of the students (76.9%) public school teachers and(78%) private school teachers. The difference between the two groups was not significant (p = 0.794). The majority (85%) of public school teachers and (87%) of private school Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article 108 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Knowledge on School Health Policy Document School Public Private Incorrect Correct Incorrect Correct F. (%) F. (%) F. (%) F. (%) Policies are written document formulated by law makers or recognized health institution to help coordinate a particular program or activities for the benefit of the population 124 (47.7) 136 (52.3) 42 (42) 58 (58) School health policy is a written guideline which helps in the effective moni- toring and evaluation of the school health program 83 (31.9) 177 (68.1) 26 (26) 74 (74) The school health program helps in the promotion of health and develop- ment of the school community 54 (20.8) 206 (79.2) 19 (19) 81 (81) The school health policy document was formulated by the ministry of education 214 (82.3) 46 (17.7) 75 (75) 25 (25) The school health policy is a framework that effectively monitor the roles of stakeholders in the school 72 (27.7) 188 (72.3) 25 (25) 75 (75) The school health policy was formulated by the joint conjunction of the min- istry of health and education 94 (36.2) 166 (63.8) 42 (42) 58 (58) School health programs enhance the comprehension and learning abilities of the students 60 (23.1) 200 (76.9) 22 (22) 78 (78) Do you know in which year the school health policy was formulated and adopted for use 253 (97.3) 7 (2.7) 95 (95) 5 (5) The provision of a safe physical, biological and socio emotional climate in the school is one of the components of the school health program 39 (15) 221 (85) 13 (13) 87 (87) School that enhances a close relationship between the school, home and the community can be considered healthy 33 (12.7) 227 (87.3) 8 (8) 92 (92) Do you have a copy of the National School Health Policy in your school 227 (87.3) 33 (12.7) 73 (73) 27 (27) Does this school has any written health related guideline or policy for use 176 (67.7) 84 (32.3) 49 (49) 51 (51) Is there any procedure in place to monitor and enforce proper implementa- tion of this policy in this school 187 (71.9) 73 (28.1) 44 (44) 56 (56) School health policy encourage skill-based health education 28 (10.8) 232 (89.2) 23 (23) 77 (77) Table 2: Distribution of the study sample according answers. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article is a very highly statistically significant difference between public and private schools in regard to the level of knowledge. 13.9% among those with 10-19 years of service, and 21.4% among those with ≥ 20 years of service (p = 0.019). Also, table4 shows that no significant association was noted between knowledge of the national school health policy document and the fol- lowing socio-demographic variables: mari- tal status (p = 0.503), income (p = 0.794), and house ownership (p = 0.440). And also the association with subject taught: no sig- nificant association was noted between knowledge on the national school health policy document and subject taught (p = 0.229). Table3 shows that the highest (74.6% of public and 56 of private) of the teachers had fair knowledge about a national school health policy (p < 0.001). And there Table4 shows that the relationship with car ownership was also highly significant (p = 0.004), that 35% of people without cars had a high degree of knowledge com- pared to 17.7% of those who had cars. Al- so shows that a significant was noted be- tween knowledge on national school health policy document with age (p = 0.031) and educational level (p = 0.053).The highest percentage (71.8%) of female teachers had fair knowledge, com- pared with 67.5% among males (p = 0.011).Around one third (31.5%) of teach- ers with less than 10 years of service had a high level of knowledge, compared with 109 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table3: Distribution of the study sample according to the levels of overall knowledge. Overall Knowledge on School Health Policy Document School Public Private Poor 28 (10.8) 8 (8) Fair 194 (74.6) 56 (56) Good 38 (14.6) 36 (36) Total 260 (100) 100 (100) P-Value of Independent Sample t-test < 0.001 VHS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article 110 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4: Distribution of the study sample according to association between socio- demographic characteristics and levels of knowledge. Socio-demographic Characteristics Overall Knowledge on School Health Policy Document P-Value Chi-Square test Poor Fair Good F. (%) F. (%) F. (%) Age Group (years) 25-37 15 (11.2) 82 (61.2) 37 (27.6) 0.031 S 38-50 18 (9.5) 144 (76.2) 27 (14.3) 51-63 3 (8.1) 24(64.9) 10 (27) Gender Male 28 (14.2) 133 (67.5) 36 (18.3) 0.011 S Female 8 (4.9) 117 (71.8) 38 (23.3) Marital Single 10 (13.5) 44 (59.5) 20 (27) 0.503 NS Married 26 (9.2) 203 (72) 53 (18.8) Divorced 0 (0) 2 (66.7) 1 (33.3) Widowed 0 (0) 1 (100) 0 (0) Education Bachelor degree 30 (9) 235 (70.1) 70 (20.9) 0.053 S Postgraduate 6 (24) 15 (60) 4 (16) Service duration < 10 8 (8.7) 55 (59.8) 29 (31.5) 0.019 S 10-19 16 (9.7) 126 (76.4) 23 (13.9) 20+ 12 (11.7) 69 (67) 22 (21.4) Subject taught English 5 (10.2) 39 (79.6) 5 (10.2) 0.229 NS Kurdish 4 (11.1) 24 (66.7) 8(22.2) Arabic 4 (9.1) 29 (65.9) 11 (25) Mathematic 8 (19) 24 (57.1) 10 (23.8) Physic 0 (0) 23 (82.1) 5 (17.9) Chemistry 1 (2.5) 29 (72.5) 10 (25) Biology 3 (7.5) 26 (65) 11 (27.5) Others 11 (13.6) 56 (69.1) 14 (17.3) Income Sufficient for daily needs 18 (9) 142 (71) 40 (20) 0.794 NS Insufficient for daily needs 18 (11.4) 106 (67.1) 34 (21.5) Exceeds need 0 (0) 2 (100) 0 (0) House Owned 21 (10.2) 138 (67) 47 (22.8) 0.440 NS Partially owned 2 (3.6) 45 (80.4) 9 (16.1) Rented 9 (13) 47 (68.1) 13 (18.8) Others 4 (13.8) 20 (69) 5 (17.2) Car Yes 34 (11.3) 213 (71) 53 (17.7) 0.004 HS No 2 (3.3) 37 (61.7) 21 (35) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article in Table 3 that more than half of public and private school teachers knew the definition of a policy, but there was no significant difference between both groups of teach- ers. A Similar finding was also reported by Abubakar AU et al, conducted in Nigeria, which found that a higher percentage of respondents had good knowledge of school health program[13]. More than two -thirds of the teachers knew the definition of school health policy, and no significant difference was detected between the two groups of teachers. The findings of the pre- sent study disagree with a study done in Nigeria by Obembe TA who found that on- ly a few of the respondents (35.5%) knew the national school health policy[12].The school health policy was created by the ministry of education, although only a little more than a quarter of teachers were aware of this. One-quarter of private teachers had knowledge about that, com- pared with one-quarters of the public teachers. This result was supported by the result of the study conducted in Ibadan Local government by Omakinwa SO, who found that the Ministry of Education does not create school health policy, according to more than half of the respondents [1]. Around three-quarters of teachers knew that the school health policy is a frame- work for efficiently observing the functions of school stakeholders. No significant difference was detected between the two groups of them. It can be compared to a study done by Ademokun OM et al, in Iba- dan, which reveals that teachers are not well-aware of the presence of national school health policy [5].Most of the schools that were visited—more than 75 percent—do not have a copy of any written document guidelines to assist in enhancing the state of staff and student health, which supports how little knowledge there is of the school health document. The school health policy was Three hundred and sixty teachers were included in the study. Their mean age (SD) was 39.8 (8.3) years, ranging from 25 to 63 years. The median was 40 years. These results are almost similar to previous studies, such as a study done by Omakin- wa, in which the age range of the re- spondents was between 23– 62 years of age with a mean age of 38.3± 7.7. [1]. The finding of the present study shows that the majority of (74%) private school teachers were aged (25-37), younger than in public schools 64.4% were aged be- tween (38 to 50) years. Because the em- ployment of teachers in public schools has stopped only in private schools, the age of private school teachers is younger than that of public teachers. It is evident in Table1 that around half of the teachers of the public schools were females com- pared with less than half of the private teachers. The current study results were similar to a study done by Obembe TA et al, conducted in Ibadan, which found that most of the respondents were males (51.9%) [12].The majority of the teachers in the public schools were married, com- pared with more than half of the private school teachers. The current study results were similar to a study by Abubakar AU, which found that the majority of respond- ents were married[13].It is evident that one quarter of the private teachers had postgraduate degrees compared with less than one quarter of teachers of the public schools. Similar findings were also report- ed by Omakinwa SO, who found that more than one quarter have a postgradu- ate degree[1].No significant difference was noticed in the income of teachers of the two groups. A Similar finding revealed in a study in the Philippines by Gregorio Jr ER, which found that there was no signifi- cant association between the school teacher’s monthly income[14].It is evident 111 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article a healthy school environment includes a safe physical environment, a biological en- vironment, and a socio-emotional environ- ment, and there was no significant differ- ence between the two groups. A similar finding revealed in a study in Ibadan by Omakinwa SO, who found that more than half of the respondents concurred that a safe physical, biological, and socio- emotional environment is a crucial compo- nent of the school health program[1]. This could be as a result of the increased attendance and concentration of students in the classroom, further elucidating re- spondents knowledge of national school health policy. The majority of the teachers (88.6%) knew that a school that enhances a close relationship between the school, home, and community can be considered healthy, and there was no significant difference between the two groups (p = 0.339). A similar finding revealed in a study in Ibadan by Obembe TA, who found that the majority of respondents, 340 (80%), agreed that parents should be informed of their children's health requirements in terms of "school, home, and community relationship[12].No significant association was detected between knowledge on the national school health policy document and the following socio-demographic vari- ables: marital status, income, and house ownership. A similar finding revealed in a study in Nigeria by Abubakar AU, who found that there was no statistically signifi- cant relation between gender and knowledge[16]. Significant association was detected between knowledge on the na- tional school health policy document with the following socio-demographic variables: age and educational level. It was in con- trast to the study carried out by Abubakar AU, who found that there was no statisti- cally significant relation between age and level of education[16]. Around more than one quarter of female teachers had high developed in partnership with the ministry of health and education, according to about two-thirds of the instructors. No significant difference was detected be- tween the private and public-school teach- ers. Similar findings were in a study in Iba- dan[1]. More than two-thirds of respond- ents agreed that the national school health policy was developed by the minis- try of health and education, and more than three-quarters believed that it aids in promoting the health and development of the school community, according to the data. This demonstrates that although the respondents were well-informed on the national school health policy content, they had little awareness about the year it was created. More than 75% of the teachers were aware that the understanding and learning skills were improved by the school health programs. The difference between the two groups was not signifi- cant. It also disagrees with the result of the study by Saadia AG concerning the awareness of national school health policy that only a few of the respondents had ever heard of the term national school health policy [15].The table also shows that only less than one-quarters of the teachers knew the year at which the school health policy was formulated and adopted for use, and there was no signifi- cant difference between the two groups. Similar findings in a study in Ibadan [1]. More than half of respondents do not know when the national school health pol- icy was created or whether it is available in their schools. This could be due to the gov- ernment not properly informing stake- holders in the education system about the policy creation and availability and anoth- er study supported by Ademokun OM, in Ibadan, which supports the fact that few teachers are aware of the existence of na- tional school health policy [5].Most teach- ers—more than 75%—were aware that 112 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article outcomes for learners with emotional and behavioral disabilities. European Journal of Business and Social Sciences. 2012 Aug;1 (5):54-69. [4] Masten AS, Obradovic J. Disaster prepara- tion and recovery: Lessons from research on resilience in human development. Ecology and society. 2008 Jun 1;13(1). [5] Ademokun OM, Osungbade KO, Obembe TA. A qualitative study on status of implementa- tion of school health programme in South Western Nigeria: Implications for healthy living of school age children in developing countries. American Journal of Educational Research. 2014 Nov 17;2(11):1076-87. [6] Amoran OE, Kupoluyi OT, Salako AA. Health- ful school environment: A comparative study of public and private primary schools in Ogun State, Nigeria. Archives of Community Medicine and Public Health. 2017 Aug 24;3 (2):062-70. [7] Gowri MA, Missiriya S. Knowledge and prac- tice of school teachers on health care of school children. International Journal of Pharma and Bio Sciences. 2017 Jan;8(1):227- 31. [8] Bisi‑Onyemaechi AI, Akani NA, Ikefuna AN, Tagbo BN, Chinawa JM. Evaluation of the school environment of public and private schools in Enugu to ensure child health pro- motion. Nigerian Journal of Clinical Practice. 2018 Feb 26;21(2):195-200. [9] Bundy D. Rethinking school health: a key component of education for all. Directions in development; human development Wash- ington, D.C. World Bank Publications; 2011. [10] Ezeonu CT, Asiegbu UV, Arua CE, Edafioghor LO, Una AF, Anyansi MN, Onwe OE. National School Health Policy in Nigeria; Survey of teachers’ perception and implementation in public schools in Ebonyi State. Nigerian Jour- nal of Paediatrics. 2022 May 3;49(1):83-9. [11] United Nations. Sustainable Development Goals- 17 goals to transform the world. Ac- cessed at https://www.un.org/ sustainable- development/ sustainable-development- goals November DATE 2018 [12] Obembe TA, Osungbade KO, Ademokun OM. Awareness and knowledge of National School Health Policy and School Health Pro- gramme among public secondary school teachers in Ibadan metropolis. Nigerian medical journal. 2016 Jul;57(4):217. knowledge, compared with one quarter among males. It was in contrast to the study carried out by Saadia AG, who found that more than half males demonstrated a good knowledge of the school health poli- cy [15]. The association with car owner- ship was also significant, where it is evi- dent that 35% of those who don’t possess a car had a high level of knowledge com- pared with more than one quarter of the car owners, because in our country, who- ever has a car goes to picnic and walk with his friends, so it will be short of time to read and get to the information. And no significant association was detected be- tween knowledge on the national school health policy document and the socio- demographic variables in both public and private schools in Erbil City. In the present study's findings, it was con- cluded that the highest percentage of the teachers had a fair level of knowledge on national school health policy documents. There was a statistically significant associa- tion between teachers’ knowledge on the national school health policy document with age, gender, level of education and service duration. There was a highly signifi- cant association between the teachers’ knowledge on the national school health policy document and car ownership. [1] Omakinwa SO. Knowledge and Practice of Healthful School Environment Among Public and Private Secondary School Teachers in Ibadan North Local Government Area, OYO State(Doctoral Dissertation). [2] World Health Organization. Regional Office for the Eastern Mediterranean. A Practical Guide to Developing and Implementing School Policy on Diet and Physical Activity. World Health Organization; 2010. [3] Lamport MA, Graves L, Ward A. Special needs students in inclusive classrooms: The impact of social interaction on educational 113 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.10 Erbil j. nurs. midwifery, Vol. 7, No. (1), May, 2024 Original Article 114 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. [13] Abubakar AU, Awosan KJ, Ibrahim MT, Ibito- ye KP. Knowledge and practice of school health program in primary and secondary schools in Sokoto metropolis, Nigeria. Inter- national Archives of Medicine and Medical Sciences. 2019;1:23-8. [14] Gregorio Jr ER, Medina JR, Lomboy MF, Tala- ga AD, Hernandez PM, Kodama M, Koba- yashi J. Knowledge, attitudes, and practices of public secondary school teachers on Zika Virus Disease: A basis for the development of evidence-based Zika educational materials for schools in the Philippines. PloS one. 2019 Mar 28;14(3):e0214515. [15] Saadia AG. Knowledge and view of teacher regarding school health program in two lo- calities Khartoum, Sudan 2019. International Journal of Sciences: Basic and Applied Re- search. 2019;45:181-6. [16] Abubakar AU, Abubakar AA, Balogun MS, Awosan KJ, Raji IA, Usman AB, Abdullahi AM, Njidda AM, Bala HA, Kaoje AU, Nguku PM. Knowledge of health effects and determi- nants of psychoactive substance use among secondary school students in Sokoto Me- tropolis, Nigeria. The Pan African Medical Journal. 2021;40. https://creativecommons.org/licenses/by-nc-sa/4.0/